It's harder to eradicate Helicobacter pylori in smokersBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7554.0-e (Published 08 June 2006) Cite this as: BMJ 2006;332:0-e
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This BMJ filler (1) summarises a fascinating study (2). It gives
further support to the view that the reservoir of H. pylori in dental
plaque on teeth cannot be removed by systemic antimicrobials and is a
significant potential source of reinfection (3).
The link between smoking and periodontitis has become well
established over the last 20 years. In addition to exacerbating
periodontitis, smoking also interferes with the treatment outcome. The
magnitude of the problem was assessed in a recent paper based on NHANES
III data, in which the authors found that smokers in the 30-75 age group
were 6 times more likely to have advanced periodontitis (4).
In patients who smoke and whose gums have been damaged by
periodontitis, there is a reservoir of dental plaque not only above the
gums, but also below the gums in periodontal pockets. As plaque is a
biofilm, organisms in it are protected from systemic antimicrobials and
must be removed mechanically by instrumentation if they are to be removed
at all. The potential for reinfection of the stomach by H. pylori is
obvious. Large clinical trials of the effect of thorough periodontal
treatment on this problem are long overdue.
(1) BMJ 2006; 332
(2) Suzuki T, et al. Smoking increases the treatment failure for
Helicobacter pylori eradication. Am J Med 2006;119: 217-24
(3) Watts T. Dental plaque is a potential reservoir of Helicobacter
pylori. BMJ 2002; 324: 614-15.
(4) Hujoel PP, et al. A hidden periodontitis epidemic during the
20th century? Community Dent Oral Epidemiol 2003; 31:1-6.
Competing interests: No competing interests